HITEQ Resources & Events

Population Specific Approaches to SDOH

Presented by: Harvard Equitable Care for Elders, National LGBT Health Education Center, Migrant Clinicians Network and National Center for Health in Public Housing

Type 2 diabetes is a chronic disease which places individuals at risk for serious long term complications and death. Risk reduction, effective treatment and management of diabetes as with many other chronic diseases are heavily dependent on social and environmental conditions. Individuals within certain special and vulnerable populations experience health inequalities and therefore are at a higher risk of late detection, inadequate management and treatment of diabetes. Improved access to certain non-clinical enabling services and a comprehensive social history is essential to understanding the needs of these often overlooked individuals, and developing interventions that address those needs. During this webinar, presenters will provide an introduction to the unique and common challenges facing this population and strategies to adapt and increase access to social enabling services.

By the end of this webinar, participants will be able to:

• Describe the impact of mobility as a social determinant of health that impacts the identification, treatment, and management of diabetes. Participants will also identify at least one resource to increase continuity of care for mobile diabetic patients.
• Articulate the social characteristics of and risk factors for diabetes in public housing residents.
• Describe the impact of social determinants of health specifically experienced by LGBTQ patients on management of diabetes and diabetes outcomes among LGBTQ patients.
•  Articulate the key role social determinants play in addressing the long term management of older adults diagnosed with Type 2 diabetes and other co-morbidities.

Pathways to Cross-Sector Partnerships to Address SDOH, Part 2

Presented By: National Center for Medical-Legal Partnership School-Based Health Alliance

Since their inception, health centers have had a special focus on identifying and addressing patients' health-related social needs in an effort to ensure optimal access to primary care. In a rapidly changing, and infinitely more complex social and health landscape, it is more important than ever that our care teams and tools evolve to meet patients where they are. As health centers work to improve their social determinants of health strategies, strategies, they must adapt new ways to solve age-old problems like poor housing and lack of income, which reverberate for health center patients and result in poor health outcomes. Join this webinar for a broad discussion of the opportunities to tackle SDOH in tandem with existing community partners and how health care teams can work together to address the social determinants of health. Special focus will be given to school-based and legal interventions that can meet the needs of patients and boost capacity of the healthcare team confronting complex SDOH. The session will review specific resources and tools. Presenters will also discuss how the above interventions can inform the dynamics and challenges of diabetes management for a range of populations.

By the end of this webinar, participants will be able to:

• Demonstrate how healthcare teams bridging across sectors like law and education can support increased access to care, improve health services delivery, and improve overall health outcomes with a focus on diabetes management.
• Identify resources available to meet the needs of pediatric and adolescent patients.
• Understand the connection between legal and health needs.

Pathways to Cross-Sector Partnerships to Address SDOH, Part 1

Presented by: Cooperation for Supportive Housing (CSH) and National Health Care for the Homeless Council

Food security and having access to safe, affordable housing are two of the most basic and yet powerful SDOH. As more and more health centers begin to screen for specific SDOH which includes housing and food security, health centers need to be equipped to triage and connect patients to appropriate partners in their local community. This webinar will highlight health centers who have developed strong relationships with local community based organizations (CBOs) to address the lack of stable housing and food for their patients; including patients with diabetes. The presenters will share examples of health centers who have built cross -sector partnerships with supportive housing providers, hospitals, and/or managed care organizations, food pantries, and soup kitchens to meet the medical and social needs of their more complex patients.

By the end of this session, participants will be able to:

• Explain how supportive housing providers can connect individuals to health centers for clinical services.
• Define food security.
• Identify promising practices for building cross-sector partnerships, to address the housing and nutritional needs of vulnerable populations, which includes patients with diabetes.
• Describe how the lack of access to safe housing and proper nutrition impacts the quality of care provided and chronic disease management.

Collecting Data on Patient SDOH & Interventions to Address Them

Presented by: National Association of Community Health Centers and Association of Asian Pacific Community Health Organizations Health Outreach Partners

A hallmark of community health centers is their ability to address the multiple, complex needs of their patient populations, both through high quality clinical services as well as non-clinical enabling services that promote full patient engagement. Having comprehensive data on both clinical and non-clinical needs is essential for understanding patient circumstances, developing interventions that address their needs, allocating resources effectively, and proving the value of services provided. During this webinar, presenters will provide an introduction to PRAPARE, a standardized, social determinant of health risk assessment tool, and how it has been used in health center settings through different workflow models, its use to inform diabetes care, and its impact on care and community transformation. They will also describe tools and resources for documenting enabling services, such as care coordination, language assistance, transportation, and/or other support services, as well as present a case study describing how efforts to track enabling services provided the data necessary to support a health center in targeting and improving diabetes management services.

By the end of this webinar, participants will be able to:

• Compare and contrast different workflow models for collecting standardized data on the social determinants of health using PRAPARE and using PRAPARE data for care and community transformation.
• List at least two ways that using PRAPARE data can inform diabetes care.
• Describe the importance of enabling services data collection and documentation in demonstrating their value in addressing patients with uncontrolled diabetes.
• Use existing resources and TA support to launch PRAPARE and Enabling Services Data Collection initiatives in their own health centers.

Assessing Readiness to Incorporate SDOH into Health Centers

Presented by: Association of Clinicians for the Underserved and Capital Link

Health centers have always been innovators, at the forefront of negotiating numerous opportunities and challenges in providing care to complex patient populations. In today’s health care environment, how can health centers best prepare to continue that legacy of innovation? What considerations should health centers evaluate before embarking on a new initiative focused on addressing social determinants of health? Before you begin a new program, join this webinar to explore the operational, financial, and workforce implications of incorporating social determinants into your health center. Presenters will explore a framework for organizational readiness to take on work that might require substantial collaboration, financial resources, and new requests of an existing team of staff and clinicians. Presenters will share real health center examples of these types of service expansions, free resources for evaluation, and suggestions for starting various levels of interventions to improve diabetes outcomes at your health center.

By the end of this webinar, participants will be able to:

• Identify major financial and workforce considerations for implementing a new program focused on addressing social determinants of health, particularly diabetes management.
• Describe the operational impact of developing new programs, and best practices to mitigate risk and minimize challenges.
• Access resources and evaluation tools.